EVERETT —The mayor of Everett sent letters to Snohomish County, the city of Marysville and the Tulalip Tribes, asking them to pick up their “fair share” of the region’s social services.

Ray Stephanson penned the letters in February as his city considered a zoning change to allow a second methadone clinic. The clinic’s operators were looking in Everett, he wrote, “because other jurisdictions, including those with citizens that are contributing to the need for the service, will not accept their fair share of such facilities.”

Stephanson this summer halted the zoning discussion in Everett. He asked staff to gather information on the role of social service providers in the downtown core, which is supposed to become more densely populated. Social issues are among the challenges of revitalization. Everyone doesn’t agree how (and where) to address homelessness, mental illness and drug and alcohol addiction. Some are critical of concentrating services in an area with existing problems, including loitering and litter. Access to treatment remains a challenge county-wide.

Now, the mayor’s research is expected to be ready for a Nov. 7 public hearing, when staff will make a recommendation to the planning commission.

Everett currently has one methadone clinic, on Evergreen Way near Holly Drive. It’s operated by Therapeutic Health Services, a Seattle-area nonprofit. THS wants to open another clinic, this time in Everett’s north end. The city planning commission was considering a zoning variance to help make that happen. The nonprofit unsuccessfully sought leases at the former Trask Surgery Center at 3025 Rucker Ave. and in a strip mall near WSU Everett.

Everett expects to spend $3.2 million this year on its Safe Streets initiative, which includes the low-barrier housing effort. A Sept. 13 report to the City Council said that Safe Streets spending had doubled from 2016. It still falls nearly a million dollars less, though, than the city’s annual bill for putting people in jail.

However, last week, the city said the estimates provided to council were too rough to draw comparisons. Safe Streets funding has not always been tracked across departments, many of which deal with social issues, said Meghan Pembroke, a spokeswoman for the mayor’s office. The 2016 figure didn’t include all spending, she said.

“Our goal for 2018 is to establish standard tracking mechanisms and evaluate year-over-year our spending to address homelessness, addiction and mental illness,” she said.

Drug abuse is one of the issues Everett hears about most from residents, said Hil Kaman, the public health and safety director.

“The city’s position has not been, ‘We are not going to allow methadone,’ ” he said. “It’s that we want to make sure the clinic is sited in a location that is consistent with our other long-term planning vision for that particular area.”

Still, local leaders need to figure out something, “if we don’t want to be walking around cleaning up needles for the rest of our lives,” Councilwoman Brenda Stonecipher said in a Sept. 6 meeting.

Methadone is one of three drugs prescribed to help people with opioid dependence. It tends to draw more attention than the alternatives, most commonly naltrexone or buprenorphine, also known as Suboxone. Everett has a handful of locations that provide Suboxone, but the city code says there can only be one methadone clinic.

The county as a whole has just two other methadone clinics, in Arlington and in Bothell’s Canyon Park area. Altogether, they serve more than 2,300 people, and they have waiting lists, officials said. The state and the county agree a fourth clinic is needed.

Opioid replacement programs are tightly regulated by the state and the federal government, and traditionally are accompanied by therapy. The programs are designed to assist people in getting clean. Detoxing without medication is a painful, miserable experience.

THS says data, including overdose rates, show the need for a methadone clinic in north Everett, which would be easier to access from Marysville and east county.

This summer, city staff met with THS and the Downtown Everett Association to discuss the zoning. Planning Director Allan Giffen summarized the conversation in an Aug. 28 memo.

THS patients are monitored to make sure they don’t disturb neighbors, and bad behavior can lead to dismissal from the program, he said.

Members of the downtown association were less concerned with the nature of the services than the potential for patients to linger. They also brought up the proximity to the Imagine Children’s Museum.

They spoke of “impacts and perceptions of impacts that discourage families from coming downtown,” he wrote.

The city had considered allowing THS a zoning variance if a site could be found on Broadway, north of 24th Street. The city even offered help finding a location, and still recommends that area, outside of downtown. Some believe the continued revamping of North Broadway will make it harder to open this kind of clinic there.

THS says no suitable properties are available on Broadway. It looked at a strip mall owned by Everett Community College, next to the WSU campus. Eventually, that land is supposed to be developed into academic buildings, said Pat Sisneros, an EvCC vice president. The college reviews potential tenants.

“We did do some research and decided it wasn’t a good fit,” Sisneros said.

THS also had in mind The Everett Clinic’s former Trask Surgery Center on Rucker. The Everett Clinic reportedly has found another buyer, but won’t answer questions. The location, in the city’s central business district, also would have required a variance. Signs saying “For Sale/For Lease” remain posted outside.

THS would prefer its clinics be zoned the same as any medical provider, said Jon Berkedal, a former deputy director who works on contract. Berkedal dislikes the term “methadone clinic” because THS serves a variety of patients with drug and alcohol addiction, and not everyone is treated with medication. Many also have mental health issues, he said. Counseling is a key part of the mission.

“The goal of THS is to return the clients back to being productive members of society,” he said.

The Trask center was ideal because the building was ready for medical use, he said. THS needs more bathrooms and plumbing than the average office building, in part to administer urine-analysis tests. Security and parking also are considerations.

THS had hoped for a long-term lease. It also has investor interest in purchasing a property, Berkedal said. The investor had placed a bid on the Trask center, which it planned to lease to THS, he said. The bid was not successful.

He calls the situation a Catch 22.

“No one’s going to lease with us knowing the process for rezoning, even in the best of circumstances, can take six months,” he said. “We’ve been at it now for a year and a half … The appearance is that the city is not in a hurry on this.”

THS continues to search for properties in Snohomish County, including Marysville and Snohomish, Berkedal said. Most local cities don’t have zoning specific to opioid treatment. Lynnwood requires a conditional use permit, as do Bothell and Mountlake Terrace. Arlington’s methadone clinic is operated by the Stillaguamish Tribe of Indians on trust land.

THS considered a property at Snohomish Station shopping center a few years back, but it didn’t work out. City Manager Larry Bauman said he’s not heard of other potential sites in town.

Marysville has five zones of land that allow opiate substitution treatment. In some, an additional permit is required. The city limits the operating hours and the distance from schools, homes and parks. It doesn’t differentiate methadone from other options.

The Tulalip Tribes did not reply to Stephanson’s letter about finding places for treatment centers. He did hear back from County Executive Dave Somers and Marysville Mayor Jon Nehring, according to documents The Daily Herald obtained under state public records laws.

The county counted about 10 unincorporated areas where a clinic could go, Somers wrote. However, it is “necessary and important” for the services to be centrally located and near transit, he said.

Somers and Nehring didn’t address Stephanson’s suggestion about shouldering a “fair share.”

Rikki King: 425-339-3449; rking@heraldnet.com; Twitter: @rikkiking.

What prescription medications are used to help people with opioid addiction?

The most common are methadone, buprenorphine (also known as Suboxone) and naltrexone (also known as Vivitrol). Apple Health, the Washington arm of Medicaid, tends to cover all three, though costs vary under private insurance. An uninsured person is facing expenses (for medication and office visits) in the hundreds of dollars a month.

Methadone only can be prescribed for opioid addiction through a designated opioid treatment site, such as a methadone clinic. Patients are given liquid to swallow in front of medical personnel. Some clinics also dispense take-home doses, after the patient meets stringent federal guidelines to move on to that step. Methadone has been used in this way since the 1970s. The treatment traditionally includes therapy. Methadone generally is the least expensive option.

Buprenorphine is taken orally (several forms are available) and can be prescribed by health care staff with certain training and a federal waiver. It also may be prescribed through an opioid treatment clinic. Its effects of euphoria are much weaker than heroin or methadone. The most common version of the drug has been on the market about 15 years.

Naltrexone is administered through a monthly injection by a health care professional. It also can be a pill. It prevents the feeling of an opioid “high,” unlike methadone (and to a lesser degree, buprenorphine), which means it’s not likely to be abused. The pill has been around in the U.S. since the 1980s and later was adapted for alcohol abuse as well. The injection form for opioid abusers is a more recent development. A period of sobriety is necessary before it can be started.

Source: This information is drawn from Snohomish County Human Services, the federal Substance Abuse and Mental Health Services Administration, Data.Medicaid.gov, the National Institutes of Health, Providence Regional Medical Center Everett, and the Washington State Health Care Authority.